Save the Children in the UK has called on infant formula manufacturers like Danone and Nestlé to do more to promote breast feeding – including larger on-pack warnings – after a report it commissioned found the companies were breaking international infant formula marketing rules.

A 1981 World Health Organisation International code limits marketing of breast milk substitutes intended for infants under six months old, but the charity said its research showed evidence of infant formula companies targeting care givers in places like China and Pakistan.

The Pakistan research was conducted by Gallup which said: "Many items were giving misleading information and were promoting bottle-feeding in some ways. The findings suggest that the code is being violated in significant ways by companies in Pakistan, which try to influence mothers through interpersonal communication, advertisements and endorsement by health professionals."

Baby food makers were given the opportunity to respond
to the report. Nestlé pointed to its breastfeeding education programmes and said: "While we agree there is still work to be done to improve infant feeding practices and promote breastfeeding around the world, we believe Nestlé already has in place the main elements recommended in the report for improving breast milk substitute industry practices."

It said: "It is unfortunate that specific companies are singled out for criticism, yet none are given credit where it is merited," adding, "We have asked Save the Children for more information on concerns raised in the report, so that we can investigate and take appropriate action if violations are found."

Felix Martin, president of Danone Baby Nutrition, disputed the call for larger labels but conceded marketing practices could be improved: "Infant formula is the only safe, legal alternative to breastfeeding and we believe an increase in the size of the warning label is counterproductive, in that it would send mixed messages to parents and potentially confuse them about which milks can be used safely for babies.”

"We accept that in some cases more work needs to be done with regard to industry marketing practices... In the absence of a global code of ethics, Danone has established clear internal marketing policies and procedures that will shortly be made public, as well as having our practices audited, both in country and at head office level by independent auditors."

It said the report did not always include the latest figures such as, "data from the Indonesia Demographic & Health Survey 2012 which shows a significant increase of breast feeding rates, as opposed to the decline in breast feeding rates documented in the report."

But the food giants did not address specific allegations in the report including gifts of branded stationery given to about 1-in-5 caregivers in Pakistan as well as free samples of infant formulas, feeding bottles and follow-on formulas.

Undermining breastfeeding?

Save the Children’s Kathryn Rawe said larger warning labels about breast feeding were not the only way to solve the problem of falling breastfeeding rates, but were a step in the right direction.

“Infant formula if used correctly, as it tends to be in countries with clean water on tap and electricity in every home, is not dangerous,” she wrote in a blog.

“In fact it is the only safe alternative to breastfeeding. But in some of the poorest countries where the rates of infant mortality are high, women simply don’t get the information they need about how best to feed their children."

“They don’t have the support and advice of a well-trained midwife and, … in countries like Pakistan and Indonesia there is evidence that some breast milk substitute companies are still marketing their products inappropriately by targeting mothers and health workers and giving out free samples.”

“These tactics that can seriously undermine breastfeeding have been almost eliminated in the UK thanks to a clampdown by government and health officials.”

Breast feeding rates are declining in much of Asia and Africa although statistics point to exceptions like Indonesia and the Philippines.

In its report - Superfood for Babies - Save the Children said breastfed babies had stronger immune systems and were better able to resist water contamination diseases and other maladies like diarrhoea. A petition it has raised on the issue has so far won more than 8000 signatures.

In its response, Mead Johnson Nutrition said the report contained, "several inaccuracies and overstates the benefits of breastfeeding and infant health. Specifically, the report contains non-factual statements regarding the ability of breastfeeding to prevent disease. There is no consistent scientific data to support such a claim."

Mike Brady, campaigns and networking coordinator at UK-based pro-breastfeeding lobby group, Baby Milk Action, said it was time infant formula manufacturers were held to account. "Nestlé and Danone have demonstrated once again that it is essential to look at what companies actually do, not just what they say they do."

"Despite their assurances, the evidence shows that both are systematically violating the marketing standards adopted by the World Health Assembly. Baby Milk Action has put four-point plans to both companies, calling on them to bring policies and practices into line and these have been repeatedly rejected."

Nestlé accounts for 23% of the global infant formula market that is worth about €18bn, with Danone possessing another 14%.

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Save the Children in the UK has called on infant formula manufacturers like Danone and Nestlé to do more to promote breast feeding – including larger on-pack warnings – after a report it commissioned found the companies were breaking international infant formula marketing rules.